NICE has ruled that women who are known to be at moderate or high risk of breast cancer should be now be offered treatment with tamoxifen or raloxifene to reduce their chance of developing the disease.
Although not licensed for preventive treatment, NICE says both treatments are equally effective at preventing breast cancer when taken for five years, reducing the risk by 30% to 40%.
The decision means women who learn they are at high risk will have another option open to them, instead of surgery to remove their breasts and, in some cases, their ovaries.
Around 50,000 women and 400 men are diagnosed with breast cancer each year in the UK, one in five of whom will have a family history of breast or ovarian cancer, or a similar cancer such as prostate. NICE estimates around 3% of all women aged 35 years or older in England and Wales could be eligible to receive either tamoxifen or raloxifene – nearly half a million women.
The updated guidance on familial breast cancer also recommends halving the threshold at which people can be offered testing for genetic mutations related to breast, ovarian and prostate cancer, such as the BRCA1 and BRCA2 mutations. Currently genetic testing is offered if people have a 20% chance or carrying either mutation based on their family history – now that threshold is to be lowered to 10%.
Dr Andrew Cuthbert, a cancer genetics counsellor and member of the guideline development group, said: ‘Faulty BRCA genes are uncommon in the population as a whole; only a small percentage of all breast cancers are caused by an inherited genetic fault. But, identifying families with hereditary breast cancer is important. Evidence shows this brings clear benefits to those who are at increased risk, by making sure they have access to extra screening, early cancer detection and risk-reducing options like surgery.
‘By reducing the criteria for offering testing for BRCA genes to 10%, more people will have access to testing. This should improve the identification of high-risk families. Working hard to implement the new guidelines across England and Wales will also help tackle inconsistencies in the detection and care [for] people with familial breast cancer.’